Brain Gain

Solving the mysteries of the 'last frontier of medicine'

A great dichotomy in medicine is how we can know so much and so little at the same time. Biomedical engineers can create devices that take over the functions of vital body organs but we still don't know exactly what causes changes in the brain that lead to depression and Alzheimer's Disease.

"The brain is the last frontier of medicine," says Dr. Nicolas Bazan, director of the Neuroscience Center at Louisiana State University's Health Sciences Center. "Very likely the human brain is one of two last frontiers of not only medicine but knowledge. The second, astrophysics, is the other frontier we have not conquered.

"If you think of any of the diseases (of the brain) you're talking about -- Alzheimer's, Parkinson's, Huntington's, depression -- no matter how early you make a diagnosis, there is no cure. In all other parts of medicine, even in cancer, if you find it early enough, there is a cure today."

As basic research continues to search for answers as to why the brain develops glitches and how it deteriorates, other medical and science professionals tackle the problems of finding ways to help people cope with the abnormalities in our body's most intricate organ. Effects of diseases that start in the brain -- the body's traffic and communication center -- can be pervasive throughout the body and cause breakdowns of other systems it normally controls. Not only do such diseases debilitate the patient, they often have a marked effect on their family and friends. Support groups, counseling and sometimes psychoanalysis can help alleviate some pressure, but in the end, they are recognized as coping techniques used to handle the hopelessness of having a disease with no cure.

"It affects everyone in the family, and as psychiatrists we need to be attuned to that or see whether family interventions are needed," says LSU psychiatrist Dr. Scott Griffies. "In addition, such diseases tend to have a hereditary factor that could shed light on treatment options. If there is a family history of depression, your risk of depression is greater. Treatments also tend to run in families. If somebody's mother tended to respond well to Zoloft, the others in the family also tend to respond well to it."

Although there isn't yet a cure, doctors say the medical profession is reporting cases of remission in depression. Still, most patients approach the process as a long-term commitment to a chronic malady.

"Recently there has been a lot of focus on improvement of depression instead of total remission," Griffies says. "We've been compromising and we've learned to accept improvement for a long time. ... We're learning now that our medications have the potential for remission in many cases."

The history of psychotropic drugs to treat brain diseases is relatively short -- only 30 to 40 years -- but already there have been marked improvements in medications that bring the brain's chemistry into balance without the sometimes-intolerable side effects.

"We have some increased knowledge in what medications can do and a refinement in the quality of medications that we have," Griffies says. "That has opened the door to people getting help where they might not have before."

The impression that a majority of Americans is being medicated for depression is spurred by a plethora of television advertisements for drugs to treat the disease, a shift from stigmatizing sufferers to accepting them as normal. Overall, there is a new recognition that depression is very common and treatable. Some experts speculate that spikes in statistics for depressive disorders also reflect successful education campaigns that have made people realize they suffer the symptoms of depression and that help is easily accessible.

"There have been increased rates of depression reported over the past 15 years," Griffies says. "Part of it is that more people are seeking treatment. We may not have an increased rate of depression, per se, but more people receiving treatment."

In 1987, for example, the rates of depression treated on an outpatient basis were about 1 in 100, he says. Ten years later, it had increased to 2.3 people out 100. Of those diagnosed in 1987, only 45 percent were treated with medication, compared to 79 percent in 1997.

"It's thought that about 69 percent of depressed people sought treatment in 1987, and about 90 percent are seeking it now," Griffies says. "We've done a lot of good in getting the word out about how treatable depression is and destigmatizing it."

Other diseases sparked by brain functions also are becoming better known and seemingly more prevalent today. Alzheimer's, most commonly known as a disease of aging in which people become forgetful and disoriented, is a growing concern not only because education has increased awareness of the disease but also because it becomes a more common problem as larger numbers of Americans live longer and actually develop Alzheimer's.

Researchers such as LSU's Bazan says his team is approaching its exploration of the brain in a holistic way, considering what effects such brain diseases have on the rest of the body or the overall well-being of a person.

"Now we're getting a grasp about the brain functions and how [Alzheimer's] happens," he says. "The brain is so complex. [The LSU Neuroscience] center ... is a crossroads of many disciplines. Because of the interdisciplinary research, it also includes clinicians or scientists from every other department in the medical schools." In addition, the center cooperates with scientists from other local institutions, such as the University of New Orleans.

In focusing on the brain, Bazan's center has established focuses on Alzheimer's; neurodegenerative diseases like Huntington's and Parkinson's; stroke and head injuries from stroke, schizophrenia and depression; pain and retinal degeneration; and glaucoma, sometimes referred to as Alzheimer's of the eye.

"What we do is basic neurobiology," Bazan says. "We call it basic or fundamental research. We're always working on opening new windows of understanding of brain diseases and brain functions. All the 12 teams (at the center) need to understand the inner workings of the brain in their goal to understand the diseases."

Dr. Griffies also agrees that depression can have systemic effects on a person and believes that some patients can benefit from not only medications that help the brain function more effectively but also psychotherapy to address their inward frustrations and problems.

"Our best studies show that a combination of both, usually together, is best," he says. "I like to look at it in a neuroscientific way. We are treating the chemistry; we're treating the abnormalities of the limbic system -- the emotional system of the brain -- with medications and they can stabilize the emotional chemistry of the brain significantly. On the other hand, you might say there are unconscious thoughts, ideas, wishes, et cetera, that come from who we are and where we've been historically that lead us to look at ourselves and the world in ways that are holdovers or are distorted perceptions from a more healthy adult reality. If you look inside yourself and get to know yourself ... you might be able to regulate those wishes, fears and conflicts in a different way. You might free yourself from a depressive or anxiety way of dealing with those."

In the meantime, researchers will keep looking for a cure. Bazan says his team is using a photon microscope to watch the contact between neurons of the brain in a live preparation instead of having to rely on a "brain bank" of dead cells. This allows physicians a "true new window to understand brain function," the doctor says. "Others let you see fixed tissue that is taken out. With this, you (not only) can look at the shape of the contact, but you can study the function and interaction."

Bazan also has applied for a patent on a new drug that would slow down the naturally occurring toxic changes in the brain that cause problems following stroke and other traumas to the brain. "Our hope is that this could actually delay the appearance of the devastating symptoms of this disease," he says. Bazan also is seeking approval for a new medication he invented for pain. Clinical trials for the drug should begin in the next two months.